Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | 070018710 | IL |
NPI | 1003163262 |
---|---|
Provider Name | Dr. Devon Beer |
First Address | Chicago, IL 60634-4403 |
Second Address | Chicago, IL 60634-4403 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/08/2012 |
Last Update Date | 07/08/2012 |